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Inspection on 28/11/05 for Howard Castle Care Centre

Also see our care home review for Howard Castle Care Centre for more information

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff make visitors very welcome and are relaxed and articulate when describing what the home has to offer and the care needs of residents. The premises are pleasant, clean and tidy with good personal touches to bedrooms and lounge areas. Staff are well trained and supportive of each other. They have coped well and worked hard since the manager left and while there has been minimal support from the new owner. The social care provision is now of a very high standard and staff and residents are more enthusiastic about life at the home. Residents comments included: "staff are kind and considerate", "there is much more going on now", " I really enjoyed the Halloween party"," doesn`t the home look better"

What has improved since the last inspection?

What the care home could do better:

The homeowner must now address outstanding requirements. The majority of these are to do with the premises and urgent issues such as evidence of gas and electrical safety must be provided if regulatory action is to be avoided. Staff were optimistic that new carpets and ongoing upgrading work would follow the commencement of redecoration. Detail of the plans to improve the premises need to be shared with the Commission. Information about the home is not yet available and this must be completed and distributed. The nurses still need guidance and support with case records and health care assessments. They reported a shortage of some nursing equipment such as adjustable beds and these must be provided. The home needs a new manager and improved support and management input from the owner. Representatives of European Care are due to meet with the inspectors. The inspectors will make further monitoring visits until they are satisfied that outstanding concerns have been addressed and that the staff are adequately supported.

CARE HOMES FOR OLDER PEOPLE Howard Castle Care Centre Dacre Street Morpeth Northumberland NE61 1HW Lead Inspector Kathryn Reid Unannounced Inspection 28th November 2005 13:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Howard Castle Care Centre Address Dacre Street Morpeth Northumberland NE61 1HW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01670 - 510634 01670 - 513529 European Care (England) Ltd Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: The home is a large two-storey building that has undergone considerable alteration to provide a care home environment. Situated near the centre of Morpeth the home is within easy walking distance of the local shops and local amenities. A small, enclosed car park is available with ramped access to the home. There are large, level landscaped gardens at the front of the house with a spacious and well-used patio area. The home can accommodate up to forty service users including those with nursing needs. The home has thirty-six bedrooms with two registered as double rooms. Fourteen of the bedrooms have en-suite facilities. There is one main dining room and three lounges. There is an adequate number of assisted bathing and shower facilities on each floor and one passenger lift. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection. It began at 1pm and lasted two hours. The home is without a manager and one of the senior nurses and the home’s administrator helped with the visit. One inspector looked around the premises, examined services and met with staff and residents. The lead inspector checked records and how the home was operating under the new ownership. Twenty-three residents were present and fifteen of these had nursing needs. One resident was in hospital. What the service does well: What has improved since the last inspection? The appointment of a social activities coordinator has greatly improved the range of stimulating activities available to individual residents. Residents themselves commented that there were more things to do and were looking forward to future events. Staff training has progressed and topics such adult protection and first aid have been covered. Improvements to the décor and furnishing of the buildings were evident and again residents and staff commented upon this. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 4 The required information about the home is not yet available for prospective residents and their families. Residents have written terms and conditions but there are uncertainties over fees. Individual care needs are assessed prior to admission and the home is able to meet the needs of the current residents. EVIDENCE: The new owners have not yet produced a completed service user guide or statement of purpose. The home staff had been working hard to produce up to date information about the home. However this matter needs to be finalised by the homeowner and copies forwarded to CSCI and distributed to the residents. Staff were unable to provide detail of the new fees or how these are individually assessed. The home now raises its own invoices and this is a new area for the administrator to deal with. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 9 Examination of the latest admission confirmed that adequate pre-admission assessments had been taken and information obtained at admission was well documented. Staff were knowledgeable about the residents’ conditions and appeared competent to meet their care needs. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Individual care plans do not include all care needs. Health needs are well met but evidence is lacking in the nursing records. Residents are protected by the home’s procedures for medications and feel their rights to privacy are respected. EVIDENCE: A selection of residents’ records was inspected. Some shortfalls in review and updates of health assessments such as pressure sore and nutritional risk were identified. There was some confusion amongst the staff as to how frequent individual reviews should be. Regular assessments of body weights are carried out. There is good evidence of relatives and residents input and agreement to care plans. Care plans remain problem orientated and this does result in gaps in some areas of information such as safety, nutrition and mental health. Mental health care needs should be included in care plans where residents have dementia. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 11 The nurses advised of a shortage of nursing beds and specialist pressure relieving mattresses. These will have to be provided with priority given to residents at the highest risk. The nurses are awaiting news of additional in-depth medications training and update. Residents are satisfied with how they are treated and approached by the staff. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14 Progress has continued to enrich residents’ social and recreational opportunities to a high standard. There is improved contact with and input from the local community. Residents are helped to exercise control and choice over their life at the home. EVIDENCE: The inspectors were able to spend valuable time with the activities coordinator and saw evidence of her work around the home. She works thirty hours per week on a flexible basis. Residents spoke of a range of events and activities organised, this included visits to Alnwick Gardens and Morpeth Town Centre. Good community links were being established with residents having visits from local schools and craft groups. The residents saw in-house events such as Halloween Parties, open days and fundraising as very positive. They commented on the purchase of new Christmas decorations and how the home looked lovely and how much they were looking forward to the staff Christmas concert. The improvement in social care has encouraged residents to make more choices and become involved in life at the home. They reported that staff are supportive and encourage them to maintain interests and choose what they want to do on a daily basis. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff are trained in adult abuse but residents are not protected by the current procedural guidance. EVIDENCE: The inspectors were advised that staff have undertaken suitable training in adult protection. The corporate adult protection policy and procedure remains unacceptable and does not follow national guidance as to who will take the lead if an allegation of abuse is made. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24 & 26 The home is well maintained but upgrade and refurbishment, including the laundry facility, is required to ensure safety throughout. There are sufficient bathing facilities but some require upgrading. There is a shortage of specialist equipment for nursing residents. Bedrooms and communal areas are comfortable, clean and pleasant. EVIDENCE: Although there is still a lot to do to improve the premises there was evidence of progress with the redecoration programme. Most of the downstairs corridors and communal areas had been/or were being redecorated and this was commented upon by residents and staff. Carpets were reportedly due to be replaced in the following weeks. The external grounds remain potholed and present a risk to residents and visitors to the home. New external signage is still awaited. Bathroom 44 has not been provided with a dropdown handrail or a suitable shower screen. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 15 Work has progressed on the fitting of suitable locks to bedrooms and providing suitable light shades, but this is not yet complete. Staff reported that replacement towels are on order. There has been no progress to the upgrade of the laundry and it would appear that the gas drier has not been serviced since its installation in 2003. Bins remain without lids and the use of toilet brushes in communal areas continues. Safety bars at bedroom windows have not been replaced with suitable restrictors. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 There is sufficient staff to meet the existing residents’ needs. The interruption to NVQ training and uncertainty over police checks could effect resident safety. Staff continue to receive other training to promote competency. EVIDENCE: Two nurses were on duty and staffing levels are sufficient to meet the needs of residents. There is a minimum of five care staff during the day and three at night. One of the senior nurses was busy planning the Christmas duty rotas. There has been no need to use agency staff. Ancillary staff cover is satisfactory but rotas were again not up to date. The nurses have kept staff up to date with training. Courses in food hygiene are booked and the majority of staff have been trained in adult protection. News of a twelve-week medications course for the nurses was expected and they had already received some provisional update. NVQ training is currently on hold due to the loss of the college assessor and the nurses were pursuing this. Staff stated that they have still not signed their terms and conditions agreement with their new employer. Staff were not sure about the management of CRB police checks and the destruction of results. This will be pursued with the homeowner. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38 There is no manager and the owner has not made suitable arrangements to provide leadership or run the home efficiently and in the residents’ best interests. Residents’ financial interests are safeguarded. Health and safety is promoted through good staff training but safety shortfalls in the premises must be addressed. EVIDENCE: The ongoing requirement to provide evidence of monthly management visits to the home has not been met and staff reported that an area manager had removed the relevant file. Mandatory training appeared up to date and the staff have received training in first aid. This does mean that a ‘first-aider’ is always on duty. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 18 Accident reports were examined and found to be satisfactory. Follow up and outcome information has not been recorded in the absence of management input. The administrator takes the lead on management of residents’ monies held for safe keeping and reported that the home now deals with accounts and payments. Concerns over unsafe carpets have not yet been addressed. There is no evidence that the gas drier in the laundry has been checked for safety. The ongoing requirement to provide the electrical installation safety certificate remains outstanding. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 1 3 2 2 X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 X X 1 Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 and 5 Requirement Provide the Commission and residents with an up to date copy of the statement of purpose and service user guide. (PREVIOUS DEADLINE TIMESCALE OF 14/11/05 NOT MET). Ensure that details of the current fees and criteria for charges are available. All health, personal and social needs must be set out in the individual care plans. (PREVIOUS DEADLINE TIMESCALE OF 30/09/05 NOT MET) Establish the frequency of individual health care assessments and ensure that review dates are met. Provide suitable and sufficient pressure relieving mattresses to meet the needs of residents. Revise the home’s adult protection policy to meet National Guidance. Provide the Commission with an audit of the condition of the premises together with written DS0000063758.V257832.R01.S.doc Timescale for action 31/12/05 2 3 OP2 OP7 5 15 31/12/05 31/01/06 4 OP8 12(1) 31/12/05 5 6 7 OP8 OP18 OP19 23(2)(n) 13(6) 23(2) 31/01/06 31/01/06 31/12/05 Howard Castle Care Centre Version 5.0 Page 21 proposals and timescales for redecoration, new carpets, upgrade and refurbishment. Make good any holes and uneven surfaces in the external grounds. Provide new signage that reflects the ownership of the home. (PREVIOUS DEADLINE TIMESCALES OF 14/11/05 NOT MET). Provide bathroom 44 with dropdown handrails and a suitable shower screen. (PREVIOUS DEADLINE TIMESCALE OF 30/11/05 NOT MET). Provide suitable adjustable beds for residents receiving nursing care. Upgrade the laundry floor and walls to provide impermeable and readily cleanable surfaces. Provide lidded and foot operated waste bins. (PREVIOUS DEADLINE TIMESCALES OF 30/11/05 NOT MET). Provide full detail of the daily management arrangements until a new manager is appointed. (PREVIOUS DEADLINE TIMESCALE OF 31/10/05 NOT MET). Provide evidence of the professional competence of the person carrying out the monthly management visits. Provide copies of the monthly visits since June 2005. (PREVIOUS DEADLINE TIMESCALES OF 31/10/05 NOT MET) Ensure that all carpets are made safe through repair or replacement. (PREVIOUS DS0000063758.V257832.R01.S.doc 8 OP21 23(2) 31/01/06 9 10 OP24 OP26 23(2) 13(3) 31/01/06 31/01/06 9 OP31 8 31/12/05 10 OP31 26 31/12/05 11 OP38 13(4)(a) 31/12/05 Howard Castle Care Centre Version 5.0 Page 22 12 OP38 13(4) and 23(2)(b) DEADLINE TIMESCALE OF 30.11.05 NOT MET). Provide a copy of the home’s electrical installation certificate. (PREVIOUS DEADLINE TIMESCALE OF 31/10/05 NOT MET). Provide evidence of the gas safety check on the laundry gas drier. 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP27 OP28 OP29 OP32 Good Practice Recommendations Review the problem orientated approach to care planning as previously discussed. Provide accurate and up to date domestic staff rotas. Progress efforts to re-establish NVQ training for the carers. Establish a system for the storage and destruction of CRB checks. Provide direction, leadership and support to the home until a manager is appointed. Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Howard Castle Care Centre DS0000063758.V257832.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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